Anterolateral leg wide-pedicle dual-vascular flap for reconstruction of traumatic midfoot and forefoot soft-tissue defects: a retrospective case series.
4 affiliations
- 1Department of Orthopaedic Surgery, The 940th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army, Lanzhou, Gansu, China.
- 2Graduate School, Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu, China.
- 3Department of Orthopaedic Surgery, The 940th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army, Lanzhou, Gansu, China. [email protected].
- 4Department of Orthopaedic Surgery, The 940th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army, Lanzhou, Gansu, China. [email protected].
Abstract
Background
Traumatic midfoot and forefoot soft-tissue defects are difficult to reconstruct because local tissue is thin, deep structures are frequently exposed, and distal pedicled flaps may develop ischaemia or venous congestion. We evaluated the clinical outcomes of an anterolateral leg wide-pedicle dual-vascular flap based on the terminal perforator of the peroneal artery and the vascular plexus accompanying the superficial peroneal nerve.Methods
We retrospectively reviewed 16 consecutive patients treated between September 2015 and June 2021. Data collected from operative and follow-up records included demographic and injury characteristics, exposed structures, associated osseous injury, defect and flap size, injury-to-coverage interval, operative time, flap-related events, infection, wound or graft dehiscence, donor-site healing, scar-related morbidity when documented, ankle range of motion, and American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score. Flap vascularity during follow-up was reassessed clinically rather than by routine vascular imaging. Results were summarized descriptively.Results
The cohort comprised 12 men and 4 women, with a mean age of 37.9 years (range 22-53 years). Injury mechanisms were traffic accidents in 6 patients and crush injuries in 10. Three patients had isolated soft-tissue defects, whereas 13 had associated fractures, dislocations, or bone defects. Exposed tendon was present in 8 patients and exposed bone in 9. Defect size ranged from 4 × 5 cm to 7 × 12 cm and flap size from 5 × 7 cm to 8 × 14 cm. Mean operative time was 100.1 min (range 75-130 min). All 16 flaps survived. One patient developed early vascular compromise on postoperative day 2 that resolved after pedicle suture release and superficial decompression; no partial flap necrosis, total flap loss, infection, wound dehiscence, donor-site graft loss requiring regrafting, or clinically relevant scar contracture was documented. Mean follow-up was 14.9 months (range 6-24 months). Four patients had mild residual pedicle oedema. All donor sites healed after split-thickness skin grafting. Final ankle dorsiflexion ranged from 15 to 20 degrees and plantar flexion from 30 to 40 degrees. Mean AOFAS midfoot score was 83.1 (range 75-90). Standardized sensory testing, pain scores, footwear tolerance, and return-to-activity measures were not consistently available in the retrospective records.Conclusions
In this small retrospective series, the anterolateral leg wide-pedicle dual-vascular flap provided reliable coverage for selected traumatic midfoot and forefoot defects without microvascular anastomosis. These findings should be interpreted as descriptive evidence rather than proof of superiority over established regional or free flaps. The proposed vascular mechanism and the sensory consequences of superficial peroneal nerve division require further dedicated evaluation.Trial registration
Not applicable.
Related
- Predictors of Salvage After Re‐Exploration of Compromised Free Anterolateral Thigh Flaps for Post‐Traumatic Extremity Reconstruction
- Reverse Anterolateral Thigh Flap for Lower Extremity Reconstruction: A Scoping Review
- High-Voltage Electrical Injury Causing a Full-Thickness Laryngotracheal Wall Defect: Reconstruction With an Anterolateral Thigh Free Flap and an Inverted Split-Thickness Skin Graft
- Independent Anatomic Double‐Bundle Anterolateral Ligament Reconstruction Using a Pedicled Gracilis Graft During Anterior Cruciate Ligament Reconstruction
- Staged Orthoplastic Soft-Tissue Reconstruction of Complex Tibial Fracture-Related Infection Using a Chimeric Anterolateral Thigh Free Flap After Failed Soleus Muscle Flap: A Case Report
BibTeX
@article{shi2026anterolateral,
title = {{Anterolateral leg wide-pedicle dual-vascular flap for reconstruction of traumatic midfoot and forefoot soft-tissue defects: a retrospective case series.}},
author = {Xianqing Shi and Yun Xue and Lihong Liu and Xiaowen Deng and Wenshuai Li and Wei Wang and Jie Shi and Peisheng Shi and Yaqiang Zhang and Guisheng Mou and Wenbo Li and Qiuming Gao},
journal = {BMC musculoskeletal disorders},
year = {2026},
month = aug,
doi = {10.1186/s12891-026-10263-8},
url = {https://europepmc.org/article/MED/42958215},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Anterolateral leg wide-pedicle dual-vascular flap for reconstruction of traumatic midfoot and forefoot soft-tissue defects: a retrospective case series.
AU - Xianqing Shi
AU - Yun Xue
AU - Lihong Liu
AU - Xiaowen Deng
AU - Wenshuai Li
AU - Wei Wang
AU - Jie Shi
AU - Peisheng Shi
AU - Yaqiang Zhang
AU - Guisheng Mou
AU - Wenbo Li
AU - Qiuming Gao
PY - 2026
DA - 2026/08/01
JO - BMC musculoskeletal disorders
DO - 10.1186/s12891-026-10263-8
UR - https://europepmc.org/article/MED/42958215
AB - Background Traumatic midfoot and forefoot soft-tissue defects are difficult to reconstruct because local tissue is thin, deep structures are frequently exposed, and distal pedicled flaps may develop ischaemia or venous congestion. We evaluated the clinical outcomes of an anterolateral leg wide-pedicle dual-vascular flap based on the terminal perforator of the peroneal artery and the vascular plexus accompanying the superficial peroneal nerve.Methods We retrospectively reviewed 16 consecutive patients treated between September 2015 and June 2021. Data collected from operative and follow-up records included demographic and injury characteristics, exposed structures, associated osseous injury, defect and flap size, injury-to-coverage interval, operative time, flap-related events, infection, wound or graft dehiscence, donor-site healing, scar-related morbidity when documented, ankle range of motion, and American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score. Flap vascularity during follow-up was reassessed clinically rather than by routine vascular imaging. Results were summarized descriptively.Results The cohort comprised 12 men and 4 women, with a mean age of 37.9 years (range 22-53 years). Injury mechanisms were traffic accidents in 6 patients and crush injuries in 10. Three patients had isolated soft-tissue defects, whereas 13 had associated fractures, dislocations, or bone defects. Exposed tendon was present in 8 patients and exposed bone in 9. Defect size ranged from 4 × 5 cm to 7 × 12 cm and flap size from 5 × 7 cm to 8 × 14 cm. Mean operative time was 100.1 min (range 75-130 min). All 16 flaps survived. One patient developed early vascular compromise on postoperative day 2 that resolved after pedicle suture release and superficial decompression; no partial flap necrosis, total flap loss, infection, wound dehiscence, donor-site graft loss requiring regrafting, or clinically relevant scar contracture was documented. Mean follow-up was 14.9 months (range 6-24 months). Four patients had mild residual pedicle oedema. All donor sites healed after split-thickness skin grafting. Final ankle dorsiflexion ranged from 15 to 20 degrees and plantar flexion from 30 to 40 degrees. Mean AOFAS midfoot score was 83.1 (range 75-90). Standardized sensory testing, pain scores, footwear tolerance, and return-to-activity measures were not consistently available in the retrospective records.Conclusions In this small retrospective series, the anterolateral leg wide-pedicle dual-vascular flap provided reliable coverage for selected traumatic midfoot and forefoot defects without microvascular anastomosis. These findings should be interpreted as descriptive evidence rather than proof of superiority over established regional or free flaps. The proposed vascular mechanism and the sensory consequences of superficial peroneal nerve division require further dedicated evaluation.Trial registration Not applicable.
SN - 1471-2474
ER -